Healthcare Provider Details

I. General information

NPI: 1124732987
Provider Name (Legal Business Name): RYAN ALEXANDER CUEVAS-NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S TACOMA WAY # WA98409
TACOMA WA
98409-4522
US

IV. Provider business mailing address

1604 KEMPTON ST SE UNIT 303
OLYMPIA WA
98501-7502
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-4354
  • Fax:
Mailing address:
  • Phone: 210-381-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: